| NPI | 1790244614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-15628) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E15628) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-03-05 |